Organization
NORTH LAKESIDE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK GRAY III (DIRECTOR)
(844) 212-5321
Entity
Organization
Contact information
Practice address
1718 N MARTIN LUTHER KING HWY, LAKE CHARLES, LA 70601-1351
(337) 433-6500
Mailing address
1718 N MARTIN LUTHER KING HWY, LAKE CHARLES, LA 70601-1351
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
06/29/2021
Last updated
07/28/2021
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